目的 探讨产科监护室妊娠期糖尿病产妇泌乳启动延迟及影响因素,以期作为预防泌乳启动延迟的参考依据。方法 选择2021年1月—2023年5月期间医院产科监护室接收的妊娠期糖尿病产妇80例为研究对象,采用单因素和多因素分析产妇的年龄、体质指数、产次、定期复查血糖、妊娠期高血压、分娩方式、开奶时间、新生儿体质量、产后焦虑、产后抑郁、产后疲乏、吸吮次数等对泌乳启动延迟的影响。结果 妊娠期糖尿病产妇泌乳启动延迟33例,发生率41.25%;泌乳启动延迟产妇的年龄≥35岁者占51.52%、未定期复查血糖者占39.39%、合并妊娠期高血压者占54.55%、开奶时间≥6 h者占57.58%、产后焦虑者占30.0%、产后抑郁者占36.36%、产后疲乏者占36.36%、吸吮次数<6次者占60.61%,与非泌乳启动延迟产妇比较差异均有统计学意义（P<0.05）。两组孕前体质指数、产次、分娩方式、新生儿出生体质量比较差异无统计学意义（P>0.05）。年龄≥35岁、未定期复查血糖、合并妊娠期高血压、开奶时间≥6 h、产后焦虑、产后抑郁、产后疲乏、吸吮次数<6次为妊娠期糖尿病产妇泌乳启动延迟的危险因素（P<0.05）。结论 产科监护室妊娠期糖尿病产妇泌乳启动延迟发生率较高,主要受到年龄、未定期复查血糖、合并妊娠期高血压、开奶时间、产后心理状态、吸吮次数等因素影响,应重视健康教育和早期辅助干预,降低泌乳启动延迟发生率。

Objective To explore the delayed lactation initiation and its influencing factors of pregnant women with diabetes in the obstetric care unit,so as to provide a reference for preventing delayed lactation initiation．Methods A total of 80 pregnant women with diabetes who were received by the hospital obstetric care unit from January 2021 to May 2023 were selected as the research objects．The age,body mass index,parity,regular blood glucose recheck,pregnancy hypertension,delivery mode,starting time,neonatal weight,postpartum anxiety,postpartum depression,postpartum fatigue,sucking times and other factors that led to the delay of lactation initiation were analyzed by single factor and multi factor analysis．Results The onset of lactation was delayed in 33 pregnant women with diabetes,with an incidence of 41.25%．The age of postpartum women with delayed lactation initiation over 35 years old accounted for 51.52%,blood sugar was not regularly rechecked accounted for 39.39%,pregnancy induced hypertension accounted for 54.55%,lactation time over 6 hours accounted for 57.58%,postpartum anxiety accounted for 30.0%,postpartum depression accounted for 36.36%,postpartum fatigue accounted for 36.36%,and sucking frequency <6 times accounted for 60.61%,which were higher than that of non-delayed lactation initiation women（P<0.05）．There was no statistically significant difference between the two groups in terms of pre pre-pregnancy body mass index,parity,delivery method and newborn birth weight（P>0.05）．The risk factors of delayed lactation initiation in pregnant women with diabetes were age ≥ 35 years,no regular blood glucose review,hypertension during pregnancy,≥ 6 h of first milk expression time,postpartum anxiety,postpartum depression,postpartum fatigue and sucking times<6（P<0.05）．Conclusions The incidence of delayed lactation initiation in pregnant women with diabetes in the obstetric care unit is high,which is mainly affected by age,pregnancy induced hypertension,time of starting breast feeding,postpartum psychological state and sucking times．Health education and early auxiliary intervention should be emphasized to reduce the incidence of delayed lactation initiation．

目的 基于计划行为理论探讨妊娠期糖尿病（GDM）孕妇自我管理行为意向,为促进其孕期良好的自我管理提供依据。方法 运用质性研究中的现象学研究方法,对12例GDM孕妇进行深度半结构式访谈,并用Colaizzi七步内容分析法对主题进行归纳。结果 根据计划行为理论对主题进行归纳,共提炼出3种类别：①行为态度：认知不足,积极态度,消极态度;②主观规范：家庭影响,医护压力,人际压力;③知觉行为控制：知识技能获取受限,客观条件束缚共8个主题。结论 GDM患者在自我管理过程中存在对疾病认知不足的问题GDM,自我管理行为受到家庭、医护人员、人际关系等外界压力对自我管理态度的影响,且存在知识技能欠缺,客观条件制约多方面阻碍。医护人员应加强对GDM孕妇的自我管理教育,适时提供支持,提高其自我管理效率。

Objective To explore the self-management behavior intention of pregnant women with gestational diabetes mellitus（GDM）based on the theory of planned behavior,and to provide a basis for promoting good self-management during pregnancy. Methods Using the phenomenological research method in qualitative research,12 pregnant women with GDM were interviewed in an in-depth semi-structured interview,and then the themes were summarized by Colaizzi's seven-step content analysis. Results According to the theory of planned behavior,the themes were summarized into three categories and eight themes including（1）Behavioral Attitudes：cognition deficiency,positive attitude,and negative attitude,（2）Subjective norms：family influence,medical pressure,interpersonal pressure,and（3）Perceptual behavior control：self-management knowledge acquisition limitations,self-management Objective conditions constraint. Conclusions Most of the respondents have insufficient awareness of self-management of gestational diabetes,different patients have different attitudes towards self-management,and self-management behavior is affected by external pressures such as family,medical staff,and interpersonal relationships,and there are many obstacles due to a lack of knowledge and skills,Objective conditions．Medical staff should strengthen the self-management education of pregnant women with gestational diabetes,provide timely support,and improve their self-management efficiency．

目的 探究脐动脉血流动力学指标、血脂、促甲状腺激素(TSH)对妊娠期糖尿病患者分娩结局的影响研究。方法 选取我院2021年1月—2021年11月收治的妊娠期糖尿病患者138例,采用随机数字表法分为对照组和研究组,每组各69例。比较2组患者体内脐动脉血流动力学指标、血脂指标及TSH相关指标表达水平差异及妊娠结局,并通过多元线性回归分析探究脐动脉血流动力学指标、血脂指标、TSH等相关指标与妊娠期糖尿病患者不良妊娠结局的相关性。结果 研究组孕妇脐动脉峰值流速/舒张末期流速(S/D)、阻力指数(RI)、三酰甘油(TG)、低密度脂蛋白(LDL)、TSH水平高于对照组,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.05);研究组孕妇巨大儿、剖宫产、新生儿低血糖发生率及新生儿体质量均高于对照组(P<0.05);多元线性回归方程显示:S/D、RI、TG、LDL、TSH水平变化均与不良妊娠结局存在相关性(R²=0.224,调整R²=0.201;F=9.504,P<0. 05),且影响顺序由大到小依次为 TG、TSH、RI、S/D、LDL。结论 妊娠期糖尿病孕妇体内的S/D、RI、TG、LDL、TSH水平异常可能会影响妊娠结局,临床可通过监测上述指标的变化,及时采取干预措施。

Objective To investigate the effects of umbilical artery hemodynamic indexes, blood lipids and thyroid stimulating hormone (TSH) on delivery outcomes in patients with gestational diabetes mellitus. Methods A total of 138 patients with gestational diabetes mellitus who were admitted to our hospital from January 2021 to November 2021 were selected and divided into a control group and a study group by random digital table, with 69 cases in each group. The differences in umbilical artery hemodynamic indexes, blood lipid indexes and TSH-related indexes and pregnancy outcomes were compared between the two groups, and multiple linear regression analysis was used to explore the relationship between umbilical artery hemodynamic indexes, blood lipid indexes, TSH, other related indexes and adverse pregnancy outcomes in patients with gestational diabetes mellitus. Results The systolic and diastolic peak volume ratio (S/D), resistive index (RI) of umbilical artery, triglyceride (TG), low density lipoprotein (LDL) and TSH in the study group were higher than those in the control group, while the levels of free triiodothyronine (FT3) and free thyroxine (FT4) were lower than those in the control group (P<0.05). The incidences of macrosomia, cesarean section, neonatal hypoglycemia and neonatal weight in study group were significantly higher than those in the control group (P<0.05). The multiple linear regression equation showed that the adverse pregnancy outcomes were correlated with changes of TG, TSH, RI, S/D, LDL levels (R²=0.224, adjusted R²=0.201; F=9.504, P<0.05), in descending order. Conclusions Abnormal levels of S/D, RI, TG, LDL, TSH and FT4 in pregnant women with gestational diabetes mellitus may affect the pregnancy outcomes. Clinical intervention measures can be taken by monitoring the changes of the above indicators.

目的 分析近年来2型糖尿病自我管理水平的研究进展,讨论其自我管理水平的影响因素及给出相应的建议。方法 通过中国知网、万方医学、迈特思创外文期刊等检索工具,搜索“2型糖尿病”“自我管理”等关键词,收集2000年—2022年相关文献资料,采用文献研究方法进行分析。结果 共检索相关文献1 053条,通过阅读文献以及文献引文,共筛选出重要文献35篇。结论 归纳总结介绍了近年来有关2型糖尿病自我管理水平的研究进展、自我管理的各个方面,包括概念、评估工具、影响因素、与糖尿病并发症的关系及提升方法等,最后文章的总结部分提出了未来研究的方向和挑战。

Objective To analyze the research progress on self-management levels of type II diabetes in recent years,discuss the influencing factors of self-management levels,and provide corresponding suggestions．Methods This article collected relevant literature from 2000 to 2022 by searching tools such as CNKI,Wanfang Medical and Medline for keywords such as “type II diabetes”and“self-management”,and analyzed the literature using a literature research method．Results A total of 1,053 relevant literature were retrieved,and 35 important literature were selected through reading literature main body and citation．Conclusions This article summarizes the research progress on self-management levels of type II diabetes in recent years,including various aspects of self-management such as concepts,evaluation tools,influencing factors,the relationship with diabetic complications,and improvement methods．The conclusion part of the article proposes directions and challenges for future research．

目的 探讨全程健康管理对糖尿病患者的血糖控制应用效果分析。方法 选择在我院门诊接受治疗的200例糖尿病患者作为研究对象,采用随机数表法分为对照组和观察组,各100例。对照组采用常规健康教育对患者进行健康指导,观察组在对照组基础上对患者行全程健康管理干预,建立糖尿病健康教育小组,对患者进行个体化的健康指导。比较2组患者干预后心理评估及空腹血糖、餐后2 h血糖的变化情况。结果 观察组患者予全程健康教育指导后,GAD-7焦虑量表及PHQ-9抑郁量表测试结果、空腹血糖及餐后2 h血糖控制效果优于对照组（P<0.05）。结论 行全程健康管理干预可有效改善糖尿病患者焦虑抑郁情绪,有效改善空腹血糖、餐后2 h血糖,增强患者自我保健意识。

Objective To explore the effect of whole process health management on blood glucose control in patients with diabetes．Methods A total of 200 patients with diabetes who were treated in the outpatient department of our hospital were studied and divided into control group and observation group,with 100 cases respectively．The patients in control group were given routine health guidance．The patients in observation group underwent whole-process health management intervention on the basis of control group,the diabetes health education group was established and individualized health coaching was given．Psychological assessment and fasting blood glucose and 2-hour postprandial blood glucose changes in the 2 groups of patients after the intervention were compared．Results After receiving whole course health education and guidance,the score GAD-7 anxity scale,PHQ-9 depression scale,pre-prandial blood glucose and 2 h postprandial blood glucose in observation group were better than those of control group（P<0.05）．Conclusions The whole process of health management intervention can improve anxiety and depression of diabetes patients,lower blood glucose levels before meals and 2 h after meals,enhance patients’ self-awareness．

目的 探讨慢性乙型肝炎病毒（HBV）感染对妊娠期糖尿病（GDM）孕妇的妊娠并发症、孕晚期生殖道B族链球菌（GBS）感染情况以及妊娠结局的影响。方法 选取2020年1月1日—12月31日在广州市妇女儿童医疗中心定期产检、足月、单胎妊娠的GDM孕妇共583例,其中合并HBV感染者（GDM+HBV组）48例,无合并者（GDM组）535例。比较2组的妊娠期并发症、妊娠晚期（妊娠35~37周）生殖道GBS感染情况、妊娠结局以及阴道分娩者的母儿结局。结果 与GDM组患者相比,GDM+HBV组患者出现妊娠期肝内胆汁淤积症、孕晚期生殖道GBS感染者比例较高,孕期出现胎盘早剥者比例较高,阴道分娩过程中出现产时发热、羊水粪染和新生儿入住NICU者比例均较高（均P<0.05）。结论 与无合并慢性HBV感染的GDM患者相比,合并慢性HBV感染的GDM患者在围产期的母儿风险升高。

Objective To investigate the effects of chronic hepatitis B virus（HBV）infection on pregnancy complications,group B streptococcus（GBS）infection in third trimester and pregnancy outcome in pregnant women with gestational diabetes mellitus（GDM）．Methods A retrospective study of 583 pregnant women with GDM,singleton gestation and cephalic presentation delivered at term in Guangzhou Women and Children’s Medical Center was carried out．Including 48 GDM women complicated with chronic HBV infection（GDM+HBV group）and 535 GDM women without HBV infection（GDM group）．Pregnancy complications,GBS infection in third trimester（gestation 35-37 weeks）,pregnancy outcomes,maternal and neonatal outcomes of vaginal delivery were compared between the two groups．Results GDM+HBV group had a higher proportion of intrahepatic cholestasis of pregnancy（ICP）and GBS infection in third trimester than GDM group,and a higher proportion of placental abruption during pregnancy．GDM+HBV group showed a significantly increased proportion in intrapartum fever,meconium-stained amniotic fluid and neonatal intensive care unit admission during vaginal delivery than GDM group（all P<0.05）．Conclusions GDM women with chronic HBV infection are associated with increased maternal and fetal risk during pregnancy and delivery．

糖尿病已成为全球最严重的健康问题之一。需要白内障手术的糖尿病患者也日益增多,虽然糖尿病的眼表并发症很常见,但由于糖尿病患者全身和眼部疾病十分复杂,使得眼前段如角结膜和泪腺的糖尿病并发症往往被忽视。糖尿病患者白内障超声乳化术有引发或加重眼前节疾病的风险,包括干眼病（DED）、角膜上皮糜烂、上皮缺损迁延不愈,甚至威胁视力的角膜溃疡。这些风险里最为常见的是DED,并且可能因白内障超声乳化手术而加重。眼科医生需要在手术前预先评估已存在的DED是否需要术前治疗,并且需要注意在已存在 DED 的情况下,各项术前检查数据测量的准确性会降低,以及尽可能减少对眼表造成损害的各种手术因素;并考虑通过管理减少术后 DED。本综述就评估白内障超声乳化术对合并糖尿病的老年性白内障患者的眼表术中的影响因素进行分析。

Diabetes mellitus(DM)has become one of the most serious health problems in the world. The number of diabetic patients requiring cataract surgery is also increasing. Although ocular surface complications of DM are common,the complexity of systemic and ocular disease in diabetic patients makes diabetic complications in the anterior segment,such as the cornea and lacrimal gland,often be overlooked. Phacoemulsification in diabetic patients carries the risk of triggering or exacerbating ocular segment disease,including dry eye disease,corneal epithelial erosion,persistent epithelial defects and even vision-threatening corneal ulcers. The most common of these risks is dry eye disease,and it can be exacerbated by cataract phacoemulsification. Ophthalmologists need to preemptively assess the need for preoperative treatment of pre-existing dry eye disease(DED),be aware of the reduced accuracy of preoperative data measurements in the presence of DED,and minimize surgical factors that can damage the ocular surface;and consider management to reduce postoperative DED. In this review,we analyze the factors that influence phacoemulsification in ocular surface surgery for senile cataract patients with diabetes.

目的 探讨绝经后2型糖尿病人群性激素水平与体质指数（BMI）的关系。方法 收集2022年1月—2023年1月在我院住院的2型糖尿病患者,随机选取自然绝经后女性184例,根据其BMI分组,其中肥胖组23例、超重组74例、BMI正常组87例,比较3组间临床资料及性激素差异。结果 3组间腰围、空腹血糖（FPG）、甘油三酯、高密度脂蛋白胆固醇、血尿酸、卵泡刺激素（FSH）、黄体生成素（LH）、雌激素（E₂）比较差异均有统计学意义（均P<0.05）,肥胖组和超重组的E₂高于正常组,FSH及LH低于正常组。3组间年龄、糖化血红蛋白、收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、催乳素、睾酮、孕酮比较差异均无统计学意义（均P>0.05）。Logistic回归分析显示,过高的腰围和较低的FSH、LH是绝经后2型糖尿病女性肥胖的影响因素。结论 2型糖尿病绝经后女性应控制腹型肥胖,定期复查LH、FSH,提早干预。

Objective To investigate the relationship between sex hormone levels and body mass index（BMI）in postmenopausal women with type 2 diabetes mellitus（T2DM）．Methods A total of 184 cases of natural postmenopausal women with T2DM admitted to our hospital from January 2022 to January 2023 were randomly selected,including 23 cases of obesity,74 cases of over weight and 87 cases of normal BMI．The clinical data and sex hormones among the three groups were analyzed．Results Waist circumference,fasting plasma glucose（FPG）,triglyceride,high density lipoprotein cholesterol,uric acid,follicle-stimulating hormone（FSH）,luteinizing hormone（LH）and oestrogen（E₂）levels were significantly different among the three groups（P<0.05）．E₂ levels of the obesity group and the over weight group were significantly higher than that of the normal group,while FSH and LH levels were significantly lower than that of the normal group．There was no significant difference in age,hemoglobin A1c,systolic blood pressure,diastolic blood pressure,total cholesterol,low density lipoprotein cholesterol,prolactin,testosterone and progesterone levels among the three groups（P>0.05）．Logistic regression analysis showed that higher waist circumference and lower FSH and LH levels were significantly correlated with obesity in postmenopausal women with T2DM．Conclusions Abdominal obesity should be controlled in postmenopausal women with T2DM,and LH and FSH should be periodically reviewed,in order to treat in advance．

目的 探究乙型病毒性肝炎不同状态合并2型糖尿病患者的临床特点。方法 对62例乙型肝炎病毒携带合并2型糖尿病(组1)、129例乙型病毒性肝炎合并2型糖尿病(组2)和83例乙型病毒性肝炎肝硬化合并2型糖尿病(组3)患者的临床资料进行回顾性分析。结果 各组间在性别和年龄上差异有统计学意义(χ²=11.133、P=0.004,F=7.640、P=0.001)。3组研究对象糖化血红蛋白(HbA1c)、总胆固醇(Tch)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)和总胆汁酸(TBA)水平差异有统计学意义(F=4.028、P=0.019,F=4.140、P=0.017,F=3.172、P=0.044,F=6.701、P=0.002,F=53.156、P<0.001,F=4.920、P=0.008,F=4.173、P=0.017,F=7.181、P=0.001,F=9.170、P<0.001)。进一步两两比较,肝炎肝硬化组HbA1c、Tch 、LDL-C、ALB水平降低,但TBIL、IBIL、TBA增高,分别与另2组比较差异有统计学意义(P<0.05);组2空腹血糖(FBG)、HDL-C水平最高,前者高于组1,后者高于组3。各组糖尿病并发症居前三的都是周围神经病变、糖尿病肾病和糖尿病视网膜病变。结论 乙型病毒性肝炎合并2型糖尿病时其不同状态间具有不同的疾病特点,主要体现在携带状态Tch、TG、LDL-C高水平,肝炎状态FBG高水平,肝炎肝硬化状态HbAlc、ALB低水平但胆红素、胆汁酸水平高,在糖尿病并发症方面均以周围神经病变、糖尿病肾病和糖尿病视网膜病变为主。

Objective To study the clinical feature of different viral hepatitis B status with type 2 diabetes. Methods A retrospective analysis was carried out on 62 hepatitis B virus carriers with type 2 diabetes (group 1),129 viral hepatitis B patients with type 2 diabetes (group 2) and 83 viral hepatitis B cirrhosis patients with type 2 diabetes (group 3). Results The differences in gender and age among the three groups were significantly different (χ²=11.133, P=0.004 and F=7.640,P=0.001). The levels of HbA1c, total cholesterol (Tch), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum albumin (ALB), total bilirubin(TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)and total bile acid (TBA)in three groups were significantly different (F=4.028, P=0.019.F=4.140, P=0.017.F=3.172, P=0.044.F=6.701, P=0.002.F=53.156, P<0.001.F=4.920, P=0.008.F=4.173, P=0.017.F=7.181, P=0.001.F=9.170, P<0.001). In further pairwise comparison, the levels of HbA1c, Tch, LDL-C and ALB of group 3 decreased significantly compared with other two groups, but the levels of TBIL, IBIL and TBA increased, with significant differences.The levels of fasting blood glucose(FBG) and HDL-C in group 2 were the highest,and the FBG was significantly higher than that in group 1, while the HDL-C was significantly higher than that in group 3.In the three groups, the top three diabetic complications were peripheral neuropathy, diabetic nephropathy and diabetic retinopathy. Conclusion Different statuses of viral hepatitis B with type 2 diabetes had different disease characteristics, mainly reflected in the high levels of Tch, TG and LDL-C in the hepatitis B virus carriers, high FBG level in the viral hepatitis B patients, low levels of HbAlc and ALB but high levels of bilirubin and bile acid in the cirrhosis patients.Peripheral neuropathy, diabetic nephropathy and diabetic retinopathy were the main complications of diabetes.

目的 系统评价胰岛素联用α-葡萄糖苷酶抑制剂(AGIs)治疗成人1型糖尿病(T1DM)的疗效和安全性。方法 检索中英文数据库,纳入关于胰岛素联用AGIs治疗成人T1DM患者的随机或非随机对照试验。使用Review Manager 5.3软件进行Meta分析。结果 共纳入10项研究,616例患者。与安慰剂或空白对照相比,在有效性方面,胰岛素联合AGIs可改善成人T1DM患者的糖化血红蛋白;降低平均血糖、空腹血糖和餐后2小时血糖;改善血糖波动情况,包括平均血糖波动幅度和最大血糖波动幅度(均P<0.05)。在安全性方面,AGIs增加总不良反应发生的风险(P<0.05),其中主要是胃肠道不适,但未增加低血糖的发生率和发生次数(均P>0.05)。胰岛素联合AGIs减少了每日胰岛素总剂量(P<0.05),但对体重、甘油三酯和高密度脂蛋白胆固醇无显著影响(均P>0.05)。结论 胰岛素联合AGIs可降低成人T1DM患者的糖化血红蛋白,改善血糖水平和血糖波动情况。AGIs不会增加低血糖的风险,但需重视其不良反应,特别是胃肠道不良反应。

Objective To systematically evaluate the efficacy and safety of adding alpha-glucosidase inhibitors (AGIs) to insulin therapy in adult patients with type 1 diabetes (T1DM). Methods Articles about randomized or non-randomized controlled trials of insulin combined with AGIs in adult patients with T1DM were retrieved from Chinese and English database. Meta-analyses were performed by using Review Manager 5.3. Results A total of 616 patients were included from 10 clinical trials. Compared with adding placebo or nothing, in terms of efficacy, the addition of AGIs resulted in decreased HbA1c, mean blood glucose, fasting plasma blood glucose and 2-hour postprandial blood glucose levels (all P<0.05). And this scheme improved the glucose variability including mean amplitude of glycemic excursions and the largest amplitude of glycemic excursions (P<0.05, respectively). As to safety, AGIs increased the risk of total adverse reactions (P<0.05), most of them were gastrointestinal complaints, while the occurrence and the frequency of hypoglycemia were similar (P>0.05, respectively). This scheme could also lead to the reduced total daily insulin dose (P<0.05) but had no significant effect on body weight, triglyceride or cholesterol concentration (P>0.05, respectively). Conclusions The addition of AGIs to insulin therapy in adult patients with T1DM may reduce HbA1c and improve the glucose levels and glucose variability. But total adverse effects especially the gastrointestinal complaints should also be considered in the use of AGIs although it does not increase the risk of hypoglycemia.